Long term survival of total knee arthroplasty. Lessons learned from the clinical outcome of old designs

Abstract

Since the initial experimentation in reconstructing damaged or degenerated knees, the evolution of knee arthroplasty (TKA) has passed through various stages. Following the era of resection and interposition arthroplasty procedures, first generation TKA implants were introduced into clinical practice by several authors. Polycentric and geometric knees were non anatomic and had several design changes during the ensuing years. Unfortunately, poor design features and fixation techniques caused a high rate of complications and failures, mainly due to aseptic loosening, instability and patellofemoral joint problems. The introduction of anatomic knees which were less constrained and closer to normal anatomy improved outcome, but the incidence of complications still remained high. However, these designs were the first critical step in the continuous evolution of TKAs since significant improvements and corrections were undertaken based on experience gained and lessons learned from their use. © Springer-Verlag London 2015.